Reasons to Encourage AED Public Access (PAD)

Public access defibrillation resources: The majority of sudden cardiac arrests (SCA) come with no previous warning. This is the reason why there must be AEDs available at all times in public areas so as to increase the survival rate of the patients. Research has proven that early defibrillation is essential in saving the life of the SCA patient. This is the rationale for public access to defibrillators , so that people with minimum AED training can perform an early defibrillation. AEDs have a 97 % success rate in ceasing ventricular fibrillation, yet fewer than half of the nation's ambulance services, less than 15 % of emergency service fire units, and less than 2 % of police vehicles are currently equipped with AEDs.

The AEDs have the advantage of being very easy to use. This fact has the potential of giving access to the members of the public to perform early defibrillation. The notion of Public Access Defibrillation (PAD) is frequently used concept today and has the power of saving many lives in critical situations.

Public access defibrillation issues

The new automated external defibrillators were particularly designed to be employed by whoever gets there first at the place of the incident, so there is no longer need to wait until medical personnel arrives. In most cases it takes more than 10 minutes for the paramedics to get to an incident scene. In the case of a sudden cardiac arrest, it is essential that the defibrillation be performed in the first 10 minutes after the occurrence of the heart arrest. Otherwise, the chances of survival of the patient are lower than 5-6 %. The AED analyses the heart rate, and will indicate to the user if a shock is needed. Presently, manufacturers have released AED models that direct the shock without the command of the user. These are fully automated AEDs. The semi-automated models will indicate the need for a shock and the user will only have to press one button in order to apply the shock.

Most AEDs that are on the market have voice prompts that will guide the user throughout the whole procedure. There are also models that incorporate a screen that will show visual commands for those who have hearing difficulties of in case the defibrillation takes place in a very noisy public area. In most American states it is mandatory to have an automated external defibrillator device in crowded locations like airports, clubs, shopping malls, schools and other public places where there is a risk of sudden cardiac arrest occurrence. This law has been passed in order to facilitate public access defibrillation .

US Occupational and Health Administration (OSHA) recommends the presence of AED devices at all workplaces. Between 1999 and 2000, 815 of 6,339 workplace victims reported to OSHA resulted from cardiac arrest. OSHA approximates that if AEDs helped restore 40 percent of those who suffer a cardiac crisis, as many as 120 lives would be saved each year. Employees who do shift work, or face daily stress, or those exposed to certain chemicals or electrical hazards are exposed to a higher risk of heart disease and cardiac arrest.

Public access defibrillation programs

There are successful PAD campaigns that are currently running in the US . For example, in Pittsburgh Subway stations 500 AEDs have been installed. The AEDs are easily recognized as they are carrying a sticker that features the international AED symbol - that is a red heart with a white lightning bolt. Other good examples of offering public access to defibrillators can be found in Indianapolis International Airport, Orlando International Airport, Colorado Springs Airport, Nashville International Airport, St. Louis International Airport/Lambert Field, Tampa International Airport and Tucson International Airport - they all carry AEDs for public access.

Only 10 months after this program has been initiated, the survival rate of SCA patients has risen to a pleasing 75%. According to a New England Journal of Medicine research carried out in casinos in Las Vegas , 74% of gamblers who experienced sudden cardiac arrest survived after getting defibrillated within 3 minutes. When American Airlines fitted automated defibrillators aboard, cardiac arrest survival rates rose to 40%.

Other successful programs include the "First Responder Defibrillator Program," in Boston . Under this program, Boston Emergency Medical Services provides CPR and AED training at no cost to any company that purchases a defibrillator. Since the program was launched, 5,000 people have been trained, automated external defibrillators have been placed in over 90 locations all over the city, and the cardiac arrest survival rate has doubled. In another triumphant program, the Rochester , MN police became the first police department in the state equipped with AEDs. Since then, cardiac arrest survival rates in Rochester have nearly doubled. In most states there are laws that protect those who have negligently used an AED.

Even if the automated external defibrillators are very easy to use, it is necessary that people benefit of some basic AED training in order to avoid negligent use of this device and make the AEDs fully effective. The basic training must consist of at least 3 or 4 hours of training.

All training programs must include the study of: proper AED use, maintenance as well as periodic inspection of the device. The trainees must also learn how to perform CPR, as this procedure is needed in the majority of sudden cardiac arrest cases. The trainees must know how to call for specialized help and how to report the incident after having identified the problem. They will get acquainted with the local EMS system. After having completed the AED course, one must be able to determine the state of a patient and whether the use of an AED is needed. The AED trainee should to be able to assess the state of the patient after the shock delivery. The trainees also have to know what precautions are needed in order to perform a safe defibrillation.

Automated external defibrillators usage by the general public

After having finished such a course, the trainee will have to pass a test so as to be able to be authorized in using an AED. A re-training should take place every two years and also some practice is strongly recommended so as not to forget the acquired skills.

Presently, there are several automated external defibrillator training courses provided by the American Heart Association (AHA) or the Red Cross on request. These institutions are highly competent in training methods and public heath and safety is the number one priority. There are also other organizations that will provide specialized training for potential AED users. Some campaigns even suggest the introduction of AED basic training in health education classes during secondary education. Media campaigns to educate and motivate "citizen responders" are being created and implemented to support PAD.

Public access defibrillation article submitted by doctor Nora Zarras